Outside imaging in emergency department transfer patients: CD import reduces rates of subsequent imaging utilization.

PURPOSE: To test the hypothesis that among emergency department (ED) transfer patients, CD import of outside examinations into the picture archiving and communication system (PACS) decreases imaging utilization in the subsequent 24 hours. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent for retrospective medical records review. In 1487 consecutive ED patients, CD import to PACS was attempted between February 1 and August 31, 2009. Subsequent rates of imaging performed within 24 hours of any CD import attempt were extracted from the electronic medical record and compared between two patient groups: those with successful CD import and those for whom CD import had failed. Rates of all subsequent imaging and of computed tomographic (CT) imaging alone were compared by using the Wilcoxon rank sum test. ED CT utilization in the successful-import group was compared with that in a historical control group of 254 consecutive ED patients transferred with outside hospital CDs between August 2007 and January 2008, prior to implementation of import procedures. RESULTS: CD import to PACS was successful in 78% (1161 of 1487) of patients. Successful CD import produced a 17% reduction (P < .001) in mean rates of all subsequent diagnostic imaging, from 3.30 to 2.74 examinations per patient in the failed-import and successful-import groups, respectively, and a 16% reduction (P = .01) in subsequent CT utilization from mean of 1.41 to 1.19 scans per patient in those respective groups. Compared with the historical control group, posttransfer utilization of CT in the ED was reduced by 29% (P < .001) from 1.18 (historical control group) to 0.84 (successful-import group) scans per patient. CONCLUSION: Among ED transfer patients, CD import of outside imaging from the sending institution into the receiving institution's PACS significantly decreased the rates of subsequent imaging utilization.

Minimally invasive reoperative thyroid surgery.

Conventional thyroid surgical techniques, introduced 100 years ago, continue to be applied in modern endocrine surgery practices. Minimally invasive approaches, however, have been proposed by Miccoli and others, and have been increasingly embraced. Reoperative thyroidectomy poses special challenges for even the expert surgeon, and these challenges are no less important when undertaking minimally invasive surgery. Nevertheless, the authors' experience with reoperative minimally invasive thyroid surgery would suggest that this approach is not only safe and effective, but confers many of the same advantages as primary minimally invasive surgery (particularly superior cosmetic results and rapid wound healing leading to early discharge). When applied judiciously, reoperative minimally invasive thyroid surgery offers advantages over conventional surgery and is an appropriate component of a high-volume head and neck endocrine practice.

Differential effects of Drosophila mastermind on asymmetric cell fate specification and neuroblast formation.

During neurogenesis in the ventral nerve cord of the Drosophila embryo, Notch signaling participates in the pathway that mediates asymmetric fate specification to daughters of secondary neuronal precursor cells. In the NB4-2 --> GMC-1 --> RP2/sib lineage, a well-studied neuronal lineage in the ventral nerve cord, Notch signaling specifies sib fate to one of the daughter cells of GMC-1. Notch mediates this process via Mastermind (Mam). Loss of function for mam, similar to loss of function for Notch, results in GMC-1 symmetrically dividing to generate two RP2 neurons. Loss of function for mam also results in a severe neurogenic phenotype. In this study, we have undertaken a functional analysis of the Mam protein. We show that while ectopic expression of a truncated Mam protein induces a dominant-negative neurogenic phenotype, it has no effect on asymmetric fate specification. This truncated Mam protein rescues the loss of asymmetric specification phenotype in mam in an allele-specific manner. We also show an interallelic complementation of loss-of-asymmetry defect. Our results suggest that Mam proteins might associate during the asymmetric specification of cell fates and that the N-terminal region of the protein plays a role in this process.